(1) Field of the Invention
The invention relates to a surgical insufflation instrument and, more particularly, to a device in which a sharp implement pierces or punctures an anatomical cavity to provide communication with the inside of the cavity.
(2) Brief Description of the Prior Art
Endoscopic surgical procedures gain access to the inside of an anatomical cavity by using an implement, such as a trocar, cannula, or a needle having a sharpened point to pierce or puncture the bodily tissues, muscles, membranes, or the like, which may form a portion or surround the cavity wall. A surgical needle, for example, connected to a catheter may be used to pierce a cavity in a blood vessel, subarachnoid space, heat ventricle, or the like. After piercing such cavity, the needle is left in situ and used to inject or withdraw gases or liquid phase fluids from the cavity or to insufflate the cavity by injection of, for example, a particular inert gas or other fluid.
Similarly, in many endoscopic procedures, a small incision may be made in the skin of a patient along the abdomen, for example, and the sharp point of a larger penetrating implement, such as a trocar of suitable length and diameter, is inserted into the incision, and pushed until the point punctures the cavity wall. Thereafter, a sleeve is slid over the exterior surface of the implement into the puncture wound to serve as a lining for preserving the shape of the passageway created by the implement. After the sleeve is in place, the implement may be withdrawn and an endoscope, or other operating instrument, may be inserted via the sleeve to view and operate upon organs within the cavity.
Penetrating the wall of an anatomical cavity with a surgical puncturing instrument can be quickly done and usually creates a small, neat, passageway providing communication to the interior of the cavity. While the sharp point of a penetrating implement is being pushed through a cavity wall, it encounters great resistance from the tissue, muscle and membranes forming the cavity wall. Once the sharp point and blade of the implement pass through the cavity wall and into the cavity, the resistance drops significantly. Due primarily to the shape of the instrument relative to the hand of the surgeon, the sharp point of the implement, however, can easily injure organ structure within the cavity upon the slightest contact.
Heretofore unless the surgeon stopped pushing the implement just as soon as penetration is complete, there has been a grave risk that the implement will continue penetrating deeply into the cavity and injure neighboring organ structures. If an unintended bodily member is injured by the point of the implement, unless an immediate and massive hemorrhage occurs, the injury may not become apparent until long after completion of the surgery. At a minimum, such an injury will delay a patient's recovery and may seriously endanger the patient's health. Accordingly, it has been observed the "pushing" or application of "thrust" while manipulating the instrument during surgery is not desirable.
Often, a preliminary, precautionary procedure is taken, particularly prior to penetration of the pelvic or abdominal cavities, in an effort to reduce the risk of injuring interior anatomical structures. After a small incision is made, a Verres-like needle or a small diameter safety endoscope, or the like, is first used to puncture the cavity wall. Thereafter, a gas, such as carbon dioxide, is next introduced into the cavity to create pneumoperitoneum, or insufflation, causing the cavity wall to bulge outwardly and separate from the organ structure inside the cavity. Then, a larger implement such as a trocar, may be used to puncture the cavity wall with a lower risk of injuring other organ structures subsequent to penetration. Despite this precautionary procedure, there are still significant incidents of injury to bowels, blood vessels, and omenta due to inadvertent contact with the sharp troccar or other needle-like configuration at the end of the surgical instrument which may be moved inside the body by even minor application of thrust with the surgeon's hand.
During pneumoperitoneum, it is extremely desirable to have a fluid passageway through the insufflation instrument to maximize flow of the insufflating fluid, such as inert gas, thereby reducing the time required to complete the pneumoperitoneum or insufflation procedure in the surgical operation.
Additionally, prior art insufflation instruments have an inner cylindrical member which has its distal end closed by means of a rubber, elastomeric, plastic or other member which typically is glued or ultrasonically secured to the inner cylindrically member. Thus, the inner cylindrically member comprises two components, which are secured one to another. Because the means for securing such members, one to another, are chemical in nature, resulting in a bonding or adhesive force, the chances of separation of the tip end of the inner cylindrical member while it is inserted through the abdominal wall during surgery, is a significant negative deterrent to such design.
Typically, such insufflation instruments will have a valving structure sealingly engageable through the proximal end of the device, with a valve element therein being manually manipulatable between opened and closed positions to control the flow of a fluid such as the insufflating gas, through a passageway through one of the cylindrical members, such as carbon dioxide through the inner of the cylindrical members. A cap element is required to be inserted onto the housing of the apparatus for receipt of such a valve element. Again, gluing or ultrasonically bonding of such elements reduces the sealing and securing integrity between the housing and such cap.
When and if the needle-like configuration of the distal end of the outer-most member of the cylindrical members forming the device, typically, passes through the abdominal wall, the inner member, defining the fluid transmission passageway therein, will be permitted to expansively telescope. Such expanded telescopic position can be visually viewed through an indicator, typically located in the housing at the proximal end of the apparatus. As surgery continues, if the distal end of the apparatus contacts an organ, blood vessel, or the like, and too much thrust force is applied through the apparatus toward such organ, the inner of the cylindrical members will overcome the bias force and will contract, thus dangerously exposing the needle-like configuration on the distal end of the outer-most cylindrical member. To indicate the occurrence of such an event, such an insufflation apparatus will have a visual indicator in the housing to indicate the positioning of the members resulting from such an occurrence. However, in the past, quick, positive and confirmed location, visually, of such indicator, has been somewhat difficult, due to poor visibility through the housing structure.
In an insufflating instrument, it is most desirable for the surgeon to have as much "feel" for the positioning and location of the instrument inside an incision or while making an incision into the abdominal wall. As stated above, use of "thrust" is not preferable, thus, any such device, the design of which encourages the use of thrust is of inferior design.
The present invention addresses the problems and deficiencies of the prior art, as discussed above.